Almost daily in the media there are stories of hospitals in crisis and of nursing shortages. Canada is facing a shortage of registered nurses that includes shortages in practicing nurses, nurses in leadership positions within health care agencies, and a looming shortage of academic nursing faculty.
While the shortages in these three areas are interrelated, this discussion will focus on the shortage of practicing registered nurses (RNs).
Factors contributing to the shortage of practicing registered nurses include an aging nursing workforce, health-care restructuring, and cuts in higher education.
Added to these factors are aging of the general population plus an increase in population, both contributing to an increase in demand for nursing services.
The Canadian nurse work force is aging and is not being replaced in numbers adequate to replace retiring nurses and meet increased needs for nursing service.
In 1995 the largest group of working RNs were in the 40-45 age range. By 2011, they will be in their mid- to late-50s and leaving the profession for retirement.
The Canadian Nurses Association predicts that by 2011, Canada will be short 100,000 practicing nurses.
In B.C., 48 per cent or 13,428 nurses, are 45-64 years of age, with 15 per cent over the age of 55. In 10 years, 33 per cent will be considering retirement.
The past decade has seen radical downsizing of hospitals in B.C. and across the country, with the closure of beds and resulting elimination of nursing positions.
Many nurses, when their positions were terminated, left the profession or moved to other countries.
In addition to hospital downsizing there was major restructuring occurring within hospitals.
Positions such as head nurses, nurse educators and clinical nurse specialists were being eliminated or decreased in number.
Front-line management positions were being changed from head nurse positions to program manager positions with a much-enlarged scope of responsibility.
These changes decreased the available support for the practice of nursing and exacerbated the historic problem of a lack of upward career mobility for nurses.
Nurses find it difficult to remain in a profession where they are unable to provide the level of care they recognize that patients require. This is a retention issue as well as a challenge for recruitment. In spite of this widespread restructuring in Canadian hospitals as well as in the United States and Europe, there was minimal evaluation of its effects on practice. However, one cross-national study is now underway, aimed at assessing the effects of hospital restructuring on patient and nurse outcomes. B.C. is one of the seven sites in five countries involved in this study.
B.C. does not currently prepare the number of registered nurses required, with 45 per cent of its nurses coming from other provinces and countries.
With a countrywide and increasingly a global shortage of qualified RNs, health-care agencies are unable to fill vacancies.
There is a perception that people are not choosing nursing as a career. Yet in September 1999 there were 97 qualified applicants denied admission to UBC's School of Nursing due to a lack of space.
The UBC School of Nursing has a unique four-year baccalaureate program in which the elective and support courses are in years one and two and the nursing courses are delivered in years three and four with an intervening summer term.
Individuals entering directly from post-secondary schools complete all four years. Individuals with a previous degree or substantial credits toward a degree are admitted into year three and complete the program in 19 months.
Of the 97 qualified applicants denied admission, 55 were applicants to year one and 42 to year three of this program.
What can be done to alleviate the shortage of registered nurses provincially, nationally and internationally?
In October 1999, the government announced the establishment of 400 new education spaces for nursing students. Where and how these spaces will be allocated has yet to be announced.
The nursing education leaders in British Columbia, and indeed across Canada, are unanimous in their conviction that all registered nurses now entering practice should hold baccalaureate degrees in nursing. This is primarily because it is increasingly difficult for diploma programs to adequately prepare graduates for the national licensing examination and the demands of clinical practice.
With the hospitals downsizing, the patients who are hospitalized are sicker and remain in hospital for shorter periods of time. With this increase in acuity, increase in the complexity of care needs, together with increased use of technology, nursing students and new graduates need assistance to make the transition to practice.
Organizations within which nursing is practiced must attend to issues in the work environment, including the restoration of leadership and support positions for the practice of nursing.
In part, employers must ensure that nurses are able to spend more time on direct patient care and less on duties such as delivering meal trays and answering phones.
Opportunities for clinical nurses to move into mentoring/teaching roles as part of their work role, exploration of clinical ladders in which practicing nurses can advance in their careers and remain at the bedside, and protected work leaves to allow practicing nurses to pursue additional education are strategies which must be explored.
Prof. Sonia Acorn is acting director of the School of Nursing. She is co-investigator for the B.C. site of an international study on the effects of hospital restructuring on patient and nurse outcomes.